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US President Donald Trump has been taken to hospital following his positive test for COVID-19, he is also reportedly being treated with monoclonal antibodies and the drug Remdesivir.
Prof Martin J Landray, Professor of Medicine & Epidemiology, Nuffield Department of Population Health , University of Oxford, said:
“The Regeneron monoclonal antibody drug is very promising but unproven. It’s action is to bind to the spike protein on the outside of the virus and prevent the virus entering cells where it would normally multiply and cause its damage.
“The Regeneron drug actually contains two different antibodies, binding at different sites on the spike protein. That’s a belt and braces approach so even if the virus were to mutate at one of those sites, the drug would still bind to the other.
“So far, several hundred patients with relatively mild disease have been given the drug in so-called phase 2 studies. These have shown that the drug is effective in reducing viral load. But they have been too small to know whether they improve patient outcomes such as reducing the duration of hospital stay, reducing the need for mechanical ventilation, or improving survival.
“Much larger clinical trials are now underway both in the US and here in the UK. Indeed the UK RECOVERY trial will be the largest trial involving up to 4,000 people in NHS hospitals with half being given the antibody drug and half being given usual standard of care alone.
“The first RECOVERY participants were given the treatment last Sunday and the drug is being dispatched to dozens of NHS hospitals over this weekend for use in the trial.
“The results from clinical trials will provide critical information:
– does the antibody treatment’s effect on viral load translate into clinical benefits for patients such as reduced hospital stay, reduced chance of requiring mechanical ventilation, and improved survival?
– if so, how big is that effect?
– and in which types of patient does it work best?
“We have been in similar situations before during this pandemic – for example, there was much hope and no little speculation that hydroxychloroquine would be a beneficial treatment for patients with COVID, but the RECOVERY trial demonstrated that it is ineffective for patients in hospital.
“By contrast, the RECOVERY trial found that dexamethasone – an inexpensive and widely available steroid drug – reduced the chance of dying by up to one third in patients with severe disease requiring ventilation.
“The RECOVERY trial is the largest trial of possible treatments for COVID. Whilst the early data on the Regeneron antibody drug is very encouraging, this large trial will tell us if that promise turns into a reality.
“Regardless of how one man with this disease fares, we need evidence from the trials before reaching firm conclusions about this treatment.
“The pandemic has already resulted in over 1 million deaths worldwide – that’s over 1 million personal and family tragedies. We need to understand which treatments are effective and how best to use them. The clinical trials will give doctors the information they need to help patients and tackle the worst manifestations of this disease.”
Prof Derek Hill, Professor of medical imaging science, UCL, and expert in medical devices, said:
“We understand Trump is being treated with Remdesivir. This drug was originally for use in hospitalised patients with low blood oxygrn. However it has recently had its emergency use authorization (FDA rapid approval process for health emergencies) expanded to include more mild patients… So you can’t really infer anything about Trump’s severity of symptoms by him being on Remdesivir”
Dr James Gill, Honorary Clinical Lecturer, Warwick Medical School, and Locum GP, said:
“Currently we have little concrete information from the Whitehouse save that Donald Trump has now been transferred to Walter Reed Hospital “out of an abundance of caution”
“Given the President of the United States often places a high level of importance on outward appearances – particularly so with regard to his previous acceptance of face masks – the announcement tonight of his transfer to the National Military Medical Centre can be interpreted as going beyond simple caution to suggest a significant concern from his team
“A concern of this nature is not unreasonable however as Donald Trump is at significant risk of complications from a COVID19 infection, his age is a major risk factor for a more serious COVID19 infection. Mortality rates from COVID19 increase significantly after age 60, by age 75 mortality estimates have risen to 1 in 25 people dying as a result of COVID, thus any worsening of his symptoms will prompt rapid response for supportive measures
“If we look at the parallel events with Boris Jonson’s COVID19 infection, where an ITU admission was required, but escalation beyond supportive measures was not required, we should not be too surprised at tonight’s report of the President of the United States being transferred to one of the worlds leading hospitals. Thus with actions being taken “out of an abundance of caution” it would be quite reasonable to expect reports of further escalations in simple supportive treatment, such as the addition of supplemental oxygen, as the President’s COVID19 infection continues.”
Declarations of interest
DOIs were not requested on this story. Please refer to previous DOIs supplied for the scientists in this round up.
Martin Landray: Regeneron have donated 2000 doses of treatment to the NHS for use in the RECOVERY trial. I have no shares or personal financial interests in any pharmaceutical company.